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Biomedical subjects

A R Caputo

Publications and source records attributed to A R Caputo.

At least 19 recordsLinked to original sources
PubMed1996

Combined paresis and restriction of the extraocular muscles after orbital fracture: a study of 16 patients.

Sixteen patients with combined paresis and restriction of extraocular muscle(s) orbital fracture repair were studied before and after in order to determine the clinical features and management of such patients. All 16 patients showed limited ductions of the involved eye in the field of action of the entrapped, paretic muscle and of the antagonist muscle after orbital fracture. Single extraocular muscles (13 patients) and two extraocular muscles (three patients) were demonstrated adjacent to the fracture site on orbital computed tomography (CT). In three patients prior to orbital surgery, a deviation in primary position was present. After fracture repair with release of the entrapped muscle in all patients, evidence of paresis of the muscle was demonstrated by underaction in its field of action and overaction in the field of its antagonist. There was a resultant manifest tropia or phoria in the primary position. In seven patients, the paresis gradually improved with no tropia and little diplopia in the functional fields of gaze. Three patients had minimal deviations and required no further treatment. Six patients with significant deviations required prisms (three patients) or strabismus surgery (three patients). The latter three patients had two muscles involved. Results of this study demonstrate that the ophthalmologist must appropriately diagnose patients with paresis and restriction of an extraocular muscle and counsel them that "new" diplopia may occur after orbital fracture repair and that this diplopia may require additional therapy.

Adolescent↗
PubMed1994

Treatment of congenital forms of telecanthus with custom-designed titanium medial canthal tendon screws.

A custom-designed, titanium medial canthal tendon screw (MCTS) was used successfully to correct telecanthus in three patients--two with blepharophimosis syndrome and one with congenital telecanthus. This device avoids the need for complicated transnasal wiring. Precise placement of the screw into the bone at the anterior lacrimal crest may be accomplished through a small skin incision. A through-and-through transverse hole in the screw just below its head allows passage of sutures and wires for internal fixation of the medial canthal tissues as well as for external fixation by a silicone stent. Correction of telecanthus with the MCTS is simpler and apparently a safer procedure than traditional transnasal wiring and, furthermore, may be easily combined with any soft tissue repair.

Blepharophimosis↗
PubMed1992

The sit-up test: an alternate clinical test for evaluating pediatric torticollis.

The sit-up test, a new evaluation method for differentiating between ocular and orthopaedic torticollis, was evaluated against the monocular occlusion test, using results of three-step testing for standardization. The study group consisted of 31 patients with torticollis between the ages of 4 and 12.5 years. Subjects were selected based only on their ability to cooperate with three-step testing. Three-step testing identified 27 of the 31 patients as having ocular torticollis, with the remaining 4 having an orthopaedic etiology. Sit-up testing correctly identified all 27 ocular torticollis patients, with no false positives or false negatives. Monocular occlusion testing detected at best 22 (81.4%) of the ocular torticollis patients, with no false positives.

Child↗
PubMed1991

Simplified limbal incision for extraocular rectus muscle surgery.

We describe a limbal incision for extraocular muscle surgery which involves only one incision to the conjunctival-Tenon's layer instead of the three separate incisions required in the standard limbal approach. Based on the 316 extraocular muscle operations in which we have used this one-snip procedure, we conclude that it is simpler and faster than the standard limbal incision, and that it provides good surgical exposure and probably less tissue damage.

Esotropia↗
PubMed1990

Nystagmus in Down's syndrome.

The incidence and characteristics of nystagmus in Down's syndrome are unclear. In 188 consecutive patients, 56 had nystagmus. Most had no clinically recognizable ocular pathology to account for the nystagmus. Twenty-nine had fine rapid horizontal nystagmus, 14 had a dissociated nystagmus which appeared pendular, whereas 9 had a form of latent or manifest latent nystagmus. Of the total patients with nystagmus, 41 had esotropia. Our findings suggest that fine rapid horizontal nystagmus, sometimes dissociated, occurs frequently in patients with Down's syndrome.

Adolescent↗
PubMed1990

Keratoconjunctivitis sicca in male patients infected with human immunodeficiency virus type 1.

Keratoconjunctivitis sicca (KCS) has not been reported as occurring as a single entity in the acquired immune deficiency syndrome (AIDS) population. In a survey of human immunodeficiency virus type 1 (HIV-1) infected male patients, the authors found that 21% (9/42) had signs and symptoms compatible with KCS with positive Schirmer test results. Tear osmolarity determinations were obtained from this group and from an age- and sex-matched group of HIV-infected patients without symptoms of KCS and with negative Schirmer test results. Eighty-nine percent of the suspect group had increased tear osmolarity, whereas none of the control patients had a hyperosmolar tear film (P less than 0.0001). Results strongly suggest that KCS occurs at a significantly greater rate in male individuals infected with HIV-1 than in the general population.

Adult↗
PubMed1990

A modified extracapsular cataract extraction for pediatric cataracts.

We present a modified procedure of extracapsular cataract extraction (ECCE) with a small central posterior capsulectomy for pediatric cataracts that is designed to eliminate posterior capsule opacification and to keep open the option of later secondary implantation of a posterior chamber intraocular lens. Of 76 study eyes in which the procedure was performed only three developed posterior capsule opacification. All seven control eyes that had standard ECCE with the posterior capsule left intact developed secondary membranes shortly after surgery.

Adolescent↗
PubMed1990

Preferred postoperative alignment after congenital esotropia surgery.

A total of 117 patients with congenital esotropia who underwent muscle surgery were included in our study and were followed for a minimum of three years. Only those patients who were orthotropic or were within +/- 10 prism diopters (PD) of orthotropia six months postoperatively were included. Of the 117 patients, 101 patients (86%) remained orthotropic or within +/- 10 PD of orthotropia three years postoperatively, but 13 patients (11%) developed consecutive exotropia (greater than 10 PD). Five years after surgery, 17 of 68 patients (25%) had consecutive exotropia (greater than 10 PD). Our study demonstrates that despite satisfactory postoperative alignment, there is a steady progression towards exotropic drift over long-term follow-up. Our study also suggests that a preferred alignment shortly after congenital esotropia surgery is within 10 PD of esotropia since all of the patients who had consecutive exotropia (greater than 10 PD) were either orthotropic or exotropic (less than or equal to 10 PD) six months after surgery.

Esotropia↗
PubMed1989

A survey of severe eye injuries in children.

We reviewed the medical records of 258 children from newborn to 20 years of age who had ocular injuries severe enough to warrant admission to United Hospitals Medical Center, Newark, NJ, over a 3 1/2-year period. In this time there were 1737 pediatric admissions for eye treatment and of these, 258 (14.85%) were directly related to trauma. Only strabismus, with 676 (38.9%) admissions, accounted for more pediatric hospitalizations for eye injuries. Balls, fists, and sticks were the most common causes of injury, and the most common diagnosis was hyphema. The majority of injuries occurred in children between 11 and 15 years of age (31%). Ocular injuries in children above 10 years of age were most commonly sports-related, whereas injuries in the home accounted for the majority of trauma in children younger than 10 years of age.

Adolescent↗
PubMed1989

Down syndrome. Clinical review of ocular features.

A total of 187 medical records of Down syndrome individuals over a 10-year period were reviewed retrospectively for strabismus, myopia, hyperopia, astigmatism, nystagmus, cataract, glaucoma, and other significant eye findings. This study showed that a higher proportion of these individuals than reported in previous studies had strabismus (57%). Refractive errors of myopia (22.5%), hyperopia (20.9%) and astigmatism (22%) were common. The primary care physician needs to be aware of the specific eye problems of Down syndrome individuals so that he or she may initiate or refer the patient for appropriate ophthalmologic care, because most of the eye findings in Down syndrome are treatable. Significant visual loss, a usually avoidable event in Down syndrome, should occur rarely.

Adolescent↗
PubMed1988

Trabeculectomy with cyclocryotherapy for infantile glaucoma in the Sturge-Weber syndrome.

Various mechanisms have been proposed to explain the pathogenesis of infantile glaucoma in the Sturge-Weber syndrome. We report the results of treating six patients with combined trabeculectomy and cyclocryotherapy. Successful control of the intraocular pressure occurred in all patients. Two patients required a second procedure at another site. We feel that the success of this procedure provides evidence that the glaucoma is secondary to elevated episcleral venous pressure in this condition.

Acetazolamide↗
PubMed1987

Congenital unilateral adduction deficit with simultaneous abduction. A variant of Duane's retraction syndrome.

Congenital adduction deficit not associated with other signs of oculomotor nerve weakness occurs infrequently. Type 2 Duane's retraction syndrome accounts for some of these cases. The authors identified three children with unilateral adduction deficits and simultaneous abduction of the eyes on attempted lateral gaze into the field of action of the apparently paretic medial rectus muscle. This is the first report of a series of patients with this condition previously termed simultaneous or synergistic divergence. All patients had a large exotropia, and two had a horizontal face turn away from the involved eye. A large (14 mm) lateral rectus muscle recession done on one of these children reduced the face turn but did not eliminate the simultaneous abduction. Clinical, intraoperative, and electromyographic data suggest that this condition is an unusual variant of type 2 Duane's syndrome.

Child↗
PubMed1987

Epibulbar choristomas containing lacrimal tissue. Clinical distinction from dermoids and histologic evidence of an origin from the palpebral lobe.

Three new cases of epibulbar choristomas, all containing lacrimal tissue, are presented and compared with those reported previously in the literature. The first and second cases were unilateral, complex choristomas, consisting of ectopic lacrimal tissue, smooth muscle, and cartilage; the first case was also remarkable for the presence of lesional tissue in the peripheral cornea and evidence of progressive growth during puberty. The third case was a bilateral, complex choristoma, manifesting epibulbar lacrimal tissue, cartilage, and smooth muscle; also associated were bilateral optic nervehead colobomas and a uniocular focus of posterior scleral cartilage demonstrated by computed tomography (CT) scanning. On clinical examination, all three lesions displayed highly vascularized thickenings of the conjunctiva with diagnostically useful gelatinous elevations, which corresponded microscopically to lobules of lacrimal tissue. In addition, all three cases had the interesting diagnostic feature of superficial corneal scarring or sclerosis, with a fine vascularity adjacent to the conjunctival lesional tissue. Electron microscopy of the third case demonstrated completely normal cytoarchitecture of the lacrimal tissue. Because of the frequent presence of Müller's smooth muscle in epibulbar lacrimal choristomas, the authors propose that these lesions represent embryologic ectopias or overly extensive field effects of the palpebral lobe of the lacrimal gland.

Adolescent↗
PubMed1986

Treatment of congenital ptosis by maximal levator resection.

The treatment of severe congenital ptosis may include frontalis suspension or maximal levator resection. A previous study of 145 consecutive frontalis suspensions for congenital ptosis showed a fairly high recurrence rate, frequent granuloma formation, and significant brow scars. In 28 patients undergoing 32 maximal levator resections utilizing our technique, 28 patients had excellent results. Two required reoperations and two additional patients had undercorrections that did not warrant reoperation. There were no significant complications. We believe that maximal levator resection is a better surgical alternative than frontalis suspension in the treatment of severe congenital ptosis whether unilateral or bilateral. In our experience, maximal levator resection provides a better cosmetic result and the recurrence rate is probably less than with frontalis suspension.

Adolescent↗
PubMed1986

Combined intraocular lens and strabismus surgery.

Ten cases of combined strabismus surgery and intraocular lens implantation were reviewed to determine if there were increased risks and complications. A review of these cases revealed the contrary was true; i.e., there were no complications arising from the combined surgery and there were benefits in the decreased hospitalization and operative time, less mental trauma, and improved muscle surgical outcome. From these results, we conclude that combined intraocular lens and strabismus surgery is efficacious and indicated in patients with strabismus and cataracts or aphakia.

Combined Modality Therapy↗
PubMed1986

Neodymium: YAG laser surgery: the treatment of pediatric cataract disease.

Cataract extraction in children has undergone dramatic changes during the past 20 years, largely as a result of technologic advances. The neodymium: yttrium aluminum garnet (Nd:YAG) laser has indirectly brought the surgical technique full circle. The posterior capsule may be preserved at surgery and treated successfully with the Nd:YAG when necessary. In 16 such cases reported here, 11 patients with congenital and five with acquired cataracts all had improved vision after treatment with the Nd:YAG laser. The youngest patient was aged four years. The safety of Nd:YAG laser therapy is supported by this study.

Adolescent↗